Seeking assistance: Hospitals in need of recruits

Health care providers are stepping up their campaign for the Legislature to pass a bill establishing state incentives to recruit medical professionals to the state.

Shortages in several key areas, including physicians, are contributing to medical costs being sharply higher in Alaska - 50 percent to 100 percent for some procedures, according to the state Division of Insurance - than in the Pacific Northwest.

Senate Bill 139, sponsored by Sen. Donny Olson, D-Nome, has been in the Senate Finance Committee since last year.

A health care coalition led by the Alaska Primary Care Association hopes to persuade senators on the Finance Committee to move the bill out of committee in time to give it a chance of passage before the Legislature's required April 19 adjournment.

The legislation establishes a program to repay part of the hefty medical school debts incurred by new physicians, dentists and eight other health occupations that are in short supply, according to Shelley Hughes, government affairs director for the Primary Care Association.

A separate cash incentive program is aimed at encouraging experienced medical professionals to work in small communities.

Health care has been expanding in Alaska, with employment in the industry rising more than 8 percent in the last two years, but there are imbalances.

"There is a good supply of specialists in urban areas. The shortage is in primary care, particularly in rural communities," as well as in certain professions like psychologsts, said Robert Sewell, a health policy expert with the state Department of Health and Social Services.

Financial aid programs have proven to be effective in recruiting and can also be used to target underserved communities and critical specialties, Sewell said. Juneau has no cardiologist, for example.

Loan repayment programs typically target young graduates just beginning medical practices, but many health providers in rural communities prefer older, experienced professionals because they usually adapt more easily to adverse weather and sometimes-challenging living conditions.

To recruit experienced professionals, a cash incentive works better.

During a Feb. 15 workshop in Anchorage, Shelley and two state Department of Health and Social Services officials, Alice Rarig and Robert Sewell, laid out statistics illustrating the seriousness of the problem.

Rarig and Sewell said the state's most recent data indicates that almost 12 percent of physician positions in health care institutions in the state, including hospitals and tribal health consortiums, are vacant. The vacancy within the tribal organizations, which serve rural communities, is 23 percent.

Similar data was reported for other skilled professions. More than 25 percent of public health nurse positions are vacant; 16 percent of physician assistant positions are vacant; and similar percentages were reported for physical therapists and psychiatrists.

The period for which positions are vacant is also lengthening, another illustration of the difficulty of recruitment. The average vacancy period is now 17 months, up from the six months that was typical a few years ago, Sewell said.

Some communities are seeing vacancies last longer, up to two years and sometimes beyond.

High turnover is another problem. Tribal health consortiums say one-third annual turnover among skilled professionals is not unusual.

Rarig and Sewell said Alaska can't compete effectively because most other states have programs that help pay for college loans and provide cash incentives.

Minnesota has seven separate programs targeting different professions, as does New Mexico, Sewell said in his presentation. North Carolina has four programs. Montana and Arkansas each have three programs, and Washington, Wisconsin and Mississippi each have two, he said.

Olson's SB 139 would pay up to $35,000 a year to recruit physicians, pharmacists and dentists, with higher amounts, up to $47,000 a year, paid for those willing to serve in communities where recruitment is hardest.

Up to $20,000 a year would be paid to recruit dental hygienists, nurses and nurse practitioners, physician assistants and physical therapists, psychologists and social workers, with the amount increasing to $27,000 a year for people willing to work in communities where such positions are hard to fill.

Payments could be made for a maximum of six years.

The state wouldn't pay the entire tab. The employer, a clinic for example, or a community being served, would match the state dollars according to an ability-to-pay formula.

Hughes said the program is estimated to cost $2.7 million in its first year and $7.9 million over the first three years. A conservative estimate shows that the efforts would attract 90 new health professionals, or roughly nine in each of the 10 occupational areas being targeted.

Sewell said programs are successful in other states, and that federal studies have shown that assistance with loan repayments and cash incentives for service in rural areas is more effective than other kinds of assistance, like scholarships.

However, scholarship programs like Alaska's current WAMI program, help Alaskan students attend out-of-state medical schools, with an obligation to return to work in the state.

Hughes said the state now spends about $2 million a year to support WAMI scholarships and generally gets 10 or more Alaskan graduates per year returning to the state.

Financial assistance programs can also be used to assure that certain types of care are available. There is an acute shortage of providers in Anchorage and Fairbanks willing to accept Medicare and Medicaid patients, for example.

Physicians in Anchorage typically prefer to be specialists because they can charge the fees needed to repay their education loans.